Making the Invisible Visible: The Pandemic and Migrant Care Work in Long-Term Care

Abstract

Live-in care, provided by mainly female migrants, has developed as a do-it-yourself welfare mechanism—hardly regulated, with undefined working times, singular labour relations and widely untraceable cash flows. Migrant carers are isolated, working in a ‘grey’ area, torn between the family in which they are working and the individual person in need of care, and very often they are also dependent on brokering agencies. The aim of this contribution is therefore to describe and analyse how the pandemic has made hidden inequalities more visible in connection with the specificities of live-in migrant care in Austria, Italy and Spain. Findings are based on a brief scoping review, including national media coverage. Results are described in terms of national caveats and strategies to respond to challenges triggered by the pandemic. Mitigating short-term strategies were implemented under pressure and at short notice, mainly influenced by the national framework conditions of live-in migrants in the respective countries. In spite of upcoming political debates regarding the regularisation of live-in care, including issues of wages and working conditions, the visibility of migrant live-in care remains tightly connected to the further development of care regimes and the acknowledgement of unpaid work as a precondition for gender equality and equal opportunities in a European and subsequently in a global dimension.

1. Introduction

The debate about equal rights between men and women has often focused on the reconciliation of work and family life. It has, however, been widely disregarded that, within the blatantly unequally divided ‘care economy’, there is also an issue of gender diversity and multiple intersecting differences among women. For instance, women with sufficient income have been able to ensure their own work–life balance by outsourcing hitherto unpaid domestic work, including care work, to other women who often have a migrant background, are poorly paid and are employed under precarious conditions. As a result, paid domestic work is taking place behind private doors and continues to be female, underacknowledged, hardly regulated and invisible (Himmelweit 2002; Lokot and Bhatia 2020). This is particularly true for familialist care regimes and countries with high wage differentials, be it internally, or be it with neighbouring countries or regions with the same language or similar culture. When it comes to long-term care, the variations in ‘invisibility’ have crystallised at even further levels. Starting from the hierarchy between formal health and social care, where long-term care institutions have for a long time been hidden on the outskirts of cities, and where staff has always felt as ‘second-class care professionals’ also in community care, those with a migrant background have been used to fill the gaps in all types of domestic work and care tasks. In the informal care sector, this is even more blatant, as family care has always been a hidden basis of capitalism and its patriarchal roots. As a functional equivalent to family care, the practice of outsourcing informal care to (poorly) paid live-in migrant carers has created new subordinates. Rather than formalising hitherto unpaid care work, a new type of hidden, invisible employment and income has evolved. Live-in care, provided by mainly female migrants, has developed as a do-it-yourself welfare mechanism—hardly regulated, with undefined working times, singular labour relations and widely untraceable cash flows. Even the terminology for this kind of (semi-)paid care work is blurred and, depending on individual countries, sometimes misleading. In the following, we shall use the term ‘live-in migrant carer’ for what is called a ’24 h carer’ or ‘personal carer’ in Austria, ‘badante’ in Italy and ‘domestic worker’ in Spain.

Migrant carers are isolated, working in a ‘grey’ area, torn between the family in which they are working and the individual person in need of care, and very often they are also dependent on brokering agencies. The result has been described as the ‘dual labour market of care’ (Winkelmann et al. 2015), but if nothing else, the pandemic has shown that there is more segmentation than that. There are partly regulated, somewhat ‘legal’, registered and unregistered migrant carers, and there are additional inequalities when it comes to undocumented migrant carers within individual countries. Moreover, there are also huge differences regarding their status in different jurisdictions, such as those relating to their tasks and responsibilities (i.e., ranging from household chores to hands-on intimate care) and entitlement to social protection benefits. For example, in Austria, live-in carers receive lower social benefits—though paying the same taxes, the amount of family allowances is adapted to purchasing-power parities in the country of their children’s residence. Among live-in carers, language skills and previous professional experiences are likely to shape the extent to which live-in carers are able to negotiate their living and working conditions in Austria.

The aim of this article is, therefore, to describe and analyse how the pandemic has made these hidden inequalities more visible in connection with the specificities of live-in migrant care in Austria, Italy and Spain. Following a short outline of care regimes and the role of migrant live-in carers in these countries, we describe the impact of the pandemic regarding the visibility of live-in care. Section 3 highlights the national response to the challenges created by and during the pandemic before concluding with a brief outlook on the future of live-in care.

1.1. Care Regimes and the Role of Migrant Live-in Carers in Austria, Italy and Spain

Austria is an example of a familialistic care regime, where a large portion of care is provided informally—at least 54% of those with care needs are cared for by one or several informal carers alone, 34% of those living at home have a mixed arrangement of formal and informal care (including live-in carers), and only 12% are cared for exclusively by formal care services, including residential care (Nagl-Cupal et al. 2018). Formal and informal care is most often provided by women, with women comprising 63% of the workforce in residential settings and 73% in care at home (Nagl-Cupal et al. 2018). In 2007, the Austrian government regulated live-in care and introduced a means-tested allowance of EUR 550 per month for those who use services of live-in carers to compensate for the additional costs in taxes and social security contributions (Leiblfinger et al. 2021). In 2017, about 25,300 individuals received this allowance (Schmidt et al. 2020). Most live-in carers commute every 2 to 4 weeks between Austria and their home country, with 80% residing in Romania and Slovakia (Kircher 2018). Live-in carers are in almost all cases self-employed and usually brokered through specialised agencies which act as an intermediate middle-man between the family and live-in carer. The agencies recruit workers and broker them, and they sometimes also organise transport to and from the sending country and collect payments (Leiblfinger et al. 2021). In Austria, the Economic Chamber acts as an interest organisation of personal carers, where self-employed live-in carers and agencies must register as members and certify at least a minimum level of training or experience in care. In 2018, 63,961 live-in carers and 612 brokering agencies were members of the Austrian Economic Chamber (Kircher 2018). Still, notwithstanding the fact that self-employed personal carers have become the largest group of members in the Austrian Economic Chamber, they continue to act in a dispersed manner, torn between the interests of their clients and their brokering agencies on which they continue to be dependent. While legally working live-in carers are visible through the registration in Austria in terms of their overall number, there are no mechanisms for collectively negotiating their working conditions because Austrian regulations in this sector have led to self-employment for almost all live-in carers.

Italy has been coined as a model of familialistic welfare regimes, meaning that, with respect to about 2.8 million older people in need, mainly daughters and wives are carrying the responsibility of care work. Over the past decades, many of them have been replaced or supplemented by at least 1 million registered live-in carers, most of them from Eastern Europe (Romania and Ukraine, Moldavia) and the Philippines. There are, however, another million domestic workers in Italy, including an estimated share of at least 60% of non-registered domestic and/or live-in care workers. This model of ‘private’ and widely invisible welfare organisation came under pressure even before the pandemic because pensions and the flat-rate care allowance (about EUR 518 per month) often do not suffice to cover the costs of care at home with a live-in carer. Almost a million families thus contribute from their budgets and assets, while their housing infrastructure is seldom appropriate for care provided at home. Additional services in the community, including home nursing or medical care, are lacking (CENSIS 2019; Fosti et al. 2022).

Compared to two decades ago, the characteristics of live-in care have changed significantly. Apart from the ageing of live-in carers themselves—today, more than 50% are above 50 years of age (as against 21% at the beginning of the century)—many of them (85%) have lived in Italy for more than six years, while this share had been at 20.7% about 20 years ago. Moreover, there is a general trend towards care ‘at a distance’, i.e., without living in, and part-time—to date, only approximately one third of all migrant carers are still live-in carers, mainly those of a higher age and of Eastern European origins (Pasquinelli and Pozzoli 2021).

Legal regulations and social security regarding live-in carers in Italy fall short compared to other employees. In Italy, live-in carers are not required to prove their level of qualifications or experience in providing care (such as in Austria); it is sufficient to simply ‘register’ with the tax and social security authorities. They are eligible for the health care provided by the National Health System but, even if registered with the social insurance agency (INPS), to which they pay pension contributions, they are not entitled to sickness benefits. Families as employers are obliged to pay in case of sickness for a maximum of 15 days in total (depending on the duration of employment), while other employees may receive a sickness benefit covering 66.7% of former wage for up to 180 days. Apart from a general law on domestic work (regulating labour rights, working time, etc.), there has been a collective agreement for domestic workers since 1974, guaranteeing a minimum wage and regulated working times. Registered domestic workers are thus covered in case of accidents. However, they have no access to unemployment benefits. By 2019, some general requirements for domestic workers (baby-sitters, cleaners and live-in carers) were defined in a national standard (UNI 11766:2019), but there is neither any control mechanism nor any other form of quality assurance system for live-in carers (Osservatorio Nazionale 2021). Moreover, the reality of care in cohabitation generally undermines the legal rights of live-in carers, called ‘badanti’ in Italian. This is particularly true for those who are not registered and represent the ‘invisible among the invisible’.

Deemed a familialistic care regime with underdeveloped formal services alongside a strong reliance on care provided by the family, 13% of the population in Spain provides informal care, with 50% of informal care provided considered as high-intensity care, i.e., more than 20 h per week (OECD 2019). Evidence of the high reliance on informal care, recent data indicate that 1.2 million Spaniards receive care or care services from the public sector, with 39.5% of these care beneficiaries specifically receiving care benefits for family care (SAAD 2022). The over-reliance on the family to provide care and fill gaps left by the public system, in conjunction with population ageing and increasing demand for care, has contributed to the growing relevance of domestic care work in Spain (De la Fuente Robles and Morales 2015). Figures from 2010 suggested that at least 10% of households with an older adult had contracted some form of both live-in and live-out domestic work (Digital Future Society 2021). With some of the highest absolute figures of migrant domestic workers in all of Europe, Spain reported 580,500 domestic workers employed in household activities at the end of 2019 according to the Spanish Labour Force Survey (in both care and housework activities), from which one third were estimated to work in the underground economy (Parella Rubio 2021). The lack of data on workers disaggregated by differentiated types of domestic work means that there are no accurate figures for the absolute number of live-in domestic workers. Estimates suggest that live-in care workers are primarily women (estimated 80%) of migrant origin, hailing predominantly from Latin America (mainly Ecuador), and are mainly undocumented (Eurofound 2020).

Throughout the past decades, several attempts have been made to improve the working conditions and labour rights of domestic workers in Spain (León 2010; ILO 2012). Two regulatory pathways currently exist for care workers in Spain. While professional carers are employed under the General Regime of the Social Security System (‘General Regime’), domestic workers tend to be covered under the Special Social Security System for Domestic Workers (‘Special System’), which provides less social protection than that under the General Regime. The 2012 reform attempted to align the labour rights of domestic workers with that of other sectors by mandating certain rights, such as the right to a written contract, sick leave, minimum wage and maximum working and minimum off-duty time. Despite the reform also mandating mandatory contributions to social security, domestic workers remained unentitled to unemployment benefits should their employment be terminated. While the onset of these reforms contributed to an increase in registrations of domestic workers (Arango et al. 2013), many remain unregistered and thus not entitled to these labour rights because of their unregistered/informal status. As a result, live-in care work has continued to be characterised by precarious working conditions, with working hours above the legal requirement and pay below minimum wage for many.

1.2. Methods

The article aims to provide an overview of the situation of live-in carers in all three countries during COVID-19 as well as related policy measures which can serve as a starting point for further research to explore these questions more in-depth. The decision to focus on 3 countries (Austria, Italy and Spain) for the analysis was two-fold: all three countries represent familialist care regimes that are specifically relying on migrant carers to fill care gaps and have developed different strategies in addressing related challenges, not least in public policies.

We began our collection of data by carrying out a review of the literature through a search on PubMed, BASE and Web of Science. Search terms consisted of English terms relating to live-in care (i.e., live-in care, 24-h care, live-in domestic care), migrants, COVID-19, and the 3 countries of interest. Inclusion criteria consisted of articles that discussed live-in care work during the pandemic since 2020 and mitigating policy measures. Given that live-in migrant care work during the pandemic is a niche topic within the realm of research on long-term care, this search returned very few hits (31), even with broad terms and inclusion criteria used, and subsequently only 2 pieces of literature were included (Leiblfinger et al. 2020, 2021) due to their relevance.

We then included grey literature and different types of documents (online reports, newspaper articles, relevant laws, ordinances and official guidelines) identified through desk research (i.e., through Google Scholar and Google). Search terms used were the same as those listed above using not only English but also German, Italian and Spanish expressions. We searched for literature discussing (1) how the situation of live-in carers in Austria, Spain and Italy was affected by COVID-19 and (2) which policy measures were taken in the three different countries regarding the situation of live-in carers during COVID-19. Taking an iterative approach, we followed up with further relevant literature and/or media coverage mentioned in the identified documents. To date, there is only limited research on live-in care with a focus on COVID-19 and the three countries. Due to the limited literature on the topic, the literature and other information were used as long as they touched on live-in care during the COVID-19 pandemic in any of the 3 countries. We reviewed the literature, looking for information on the different ways in which (1) the situation of live-in carers was affected and (2) the different government measures developed. The findings of the literature review were then summarized.

In the following, we first describe the different aspects of the ‘visibility’ of migrant live-in care work that has been augmented since the onset of the pandemic. We then highlight public and private activities that contributed to this visibility and/or tried to attenuate the negative consequences that were linked to the emergence of hitherto hidden care work. Finally, we outline some recommendations for future-oriented policies that will need to address and acknowledge care work as a fundamental pillar of sustainable societies.

2. The Pandemic as a Magnifying Glass

The onset of COVID-19 highlighted a large range of issues linked to societal resilience and to solidarity as well as to opportunities for public support. At the same time, the pandemic also stressed societal shortcomings and concerns that had hitherto been brushed under the carpet (Power 2020). The situation of different groups of migrant carers was certainly among these. With the exception of Austria, there is no EU Member State that has introduced a full-fledged legal framework addressing the status of ‘personal carers’, i.e., their accreditation, education and training, working conditions, social security, quality assurance and duties and responsibilities (i.e., which types of care activities live-in carers are allowed to carry out) as against the formal care workforce. The lack of full legal frameworks and regulations for live-in carers at the onset of the pandemic in Spain and Italy meant that there were no mechanisms or responsible stakeholders for addressing newly arising issues. Even in the case of Austria where live-in care work has long been recognized and regulated, the pandemic served to highlight gaps and cracks in the systems unaddressed prior. Conflicts of interest among the various stakeholders particularly came to the fore together with the temporarily critical visibility of care work that has been continuously outsourced to migrant live-in carers in many European care regimes.

2.1. A Brief Glance at Migrant Carers’ Importance in Austria

While live-in carers are from a legal perspective more visible in Austria compared to other European countries, their interests are often subordinated to those of other actors (care receivers, agencies, states) in the field of LTC. This was also the case during the COVID-19 pandemic (Leiblfinger et al. 2021). At the start of the pandemic, some reports in mass media (e.g., Scherndl 2020) and campaigns on social media (Schmidt et al. 2020) highlighted particular difficulties faced by live-in carers. The Austrian system of live-in care was disrupted at the onset of the pandemic: border closures, lack of transport and quarantine requirements (for 14 days after crossing the border into Austria) meant that live-in carers could not follow their usual shifts of commuting to and from Austria every two to four weeks from their countries of residence (Leiblfinger et al. 2021). Those who were in Austria at the beginning of the first lockdown were left without a colleague who could take over after their shift, while those who were outside the country were left without an income (Schmidt et al. 2020). Carers had to find ways to inform themselves and to organise protective gear while information on the pandemic and regulations in Austria were not routinely translated into their mother tongues (Schmidt et al. 2020). Social isolation regulations meant fewer visits to care receivers which resulted in less time off for live-in carers (Leiblfinger et al. 2021). Due to their self-employment status of live-in carers, they did not receive any sick pay in case of an infection. There were no regulations on what should happen in case of an infection of the live-in carer, the cared-for person or another household member.

2.2. More Visibility in Spite of Social Distancing in Italy

At the onset of the pandemic in Italy, the precarious and concealed situation of live-in carers inside households contributed to a number of additional challenges that remain poorly documented even by media coverage. Most carers remained isolated with the person being cared for within the household. In particular, during the very strict periods of lockdown, they were working for months around the clock without any break (Il Fatto Quotidiano 2020a). Still, and in line with the general spreading of COVID-19 in Italy, many live-in carers were also affected by the virus as physical distancing was not an option in caring, protective gear was not at disposal, and infections occurred both ways. According to data by the Association of Employers of Domestic Workers (DOMINA) the average number of days of absence for sickness increased in 2020 to 16 days as compared to around 10 days for the previous decade (Osservatorio Nazionale 2021). Infections then often resulted in the decease of the older person being cared for—leaving the live-in carer without work and housing. A third group (estimates are about 15%), consisting of both registered and unregistered carers, were dismissed at the onset of the lockdown as families staying at home took over themselves (Il Fatto Quotidiano 2020b). Indeed, many migrant carers thus returned back home, where they were frequently accused of importing the virus—and found themselves without income.

During the second and third wave, in concomitance with the start of vaccination campaigns, a new issue occurred as many migrant carers from Eastern Europe refused vaccination, did not have the possibility to get vaccinated or were vaccinated with non-registered vaccines (Sputnik or Sinovac) which led to conflicts with general rules and within the respective family context. By 15 October 2021, all health and social care workers in Italy were obliged by law to get vaccinated—without the so-called ‘green pass’ they were not allowed to work anymore. The same applied to domestic workers as they are caring for particularly vulnerable groups. Personal assistants refusing to get immunised risked being dismissed (La Repubblica 2021; Il Fatto Quotidiano 2021) and/or fined between EUR 600 and EUR 1500. In fact, it is the employer, i.e., the family who is responsible for controlling and risks a fine from EUR 400 to EUR 1000. Testing every 48 h has been a costly alternative. Still, as these relations take place behind private walls, controls are usually not happening, leaving families themselves with the decision either to lose the migrant carer or to live with the risk of being fined. By February 2022 when all Italian citizens over 50 were obliged to get vaccinated, it was, however, estimated that around 5% of ‘no vax’ carers worked in ‘no vax’ families—unregistered, at high risk and without any control (La Repubblica 2022; Il Messaggero 2022). The exposure of domestic workers to public policies was thus once more obstructed by the idiosyncrasies of this type of work itself—while even the registered domestic care workers encounter difficulties accessing COVID-19 support measures provided (legal decree ‘Cura Italia’: DL 17 marzo 2020, n. 18), it has been impossible for those who are not registered to step out of their obscurity.

A next stage in the pandemic could be observed between the various lockdowns, with specific impact on the (in)visibility of migrant live-in carers. For instance, with the reduction in smart working and the return to work of a rising number of employees since the beginning of 2022, there has also been a rising demand for live-in care workers in Italy, which partly resulted in higher wages offered.

2.3. Growing Visibility Alongside Further Deterioration in Working Conditions in Spain

As similarly seen in other sectors, the onset of the pandemic contributed to a substantial reduction in domestic workers (both live-in and live-out) in Spain, from 580,500 registered at the end of 2019 to 372,654 in June 2020 (Parella Rubio 2021). With no disaggregated information on live-in carers specifically, it is unclear how these changes were distributed among live-in and live-out carers. It is possible that the number of live-in carers increased, as many live-out domestic workers switched to live-in care to protect the care receiver from contagion. As evidence of their limited bargaining power, in many cases, these workers were forced to move in with the care receiver, or otherwise risk being dismissed by their employer (van Hooren 2020; de Diego-Cordero et al. 2022).

Similar to Austria and Italy, the onset of the pandemic marked a further deterioration in working conditions for live-in care workers in Spain. While some left the country to return home as borders closed (i.e., Romanian care workers), others stayed and became trapped, uncertain about when measures would be lifted (Marcu 2021). Live-in care workers that remained in Spain (even those properly registered with the public system) faced isolation, increased anxiety, difficulties conciliating their own family and work life, increased risk of infection and limited adequate safety measures, all the while with additional working hours and less free time with no pay increases (de Diego-Cordero et al. 2022; Parella Rubio 2021). Their positions as live-in carers became increasingly precarious and unstable, whereby losing their employment would mean not only losing their income but also the home they lived in (Parella Rubio 2021). Without an official employment contract or any guaranteed labour rights, live-in carers could be let go at any time (Marcu 2021).

Unregistered live-in workers were often unable to leave the house during lockdown periods without a certificate from their employer confirming their employment in fear of facing labour inspections (Marcu 2021). Those that chanced to leave the house without a certificate during lockdowns and were caught by authorities faced deportation and expulsion orders (van Hooren 2020). Despite the exacerbated labour shortages faced by the residential care sector during the pandemic, undocumented migrant care workers that were willing to fill these shortages were unable to without legal residence papers (van Hooren 2020).

The deterioration in working conditions for migrant care workers during the pandemic in part contributed to raising the visibility of migrant care workers and the precariousness of their situation. More recently, Spain made headlines when the Court of Justice of the European Union ruled that the treatment of social protection rights of domestic workers in the country, namely the prohibition of workers to contribute taxes to future unemployment benefits, was contradicting EU laws and was discriminatory to women who comprise a majority of these workers (Court of Justice of the European Union 2022). This decision states that in principle, all domestic workers contributing to social insurance should be entitled to unemployment benefits, should they lose their job. It remains to be seen whether this decision will materialize into policies that entitle domestic workers to unemployment benefits.

In addition, the growing visibility of migrant domestic workers, and particularly live-in workers, has become evident through the increasing popularity of digital platforms for hiring care. Digital platforms for care services, similar to those for food delivery, have existed in Spain since 2015 in the form of two models: (1) digital placement agencies that act as a bridge to contract care between care workers and care recipients and (2) on-demand models where workers independently manage their own profile and services (Digital Future Society 2021). As much as half of the services contracted by digital placement agencies are for live-in care services, while live-in care is not available in the latter on-demand model. The onset of the pandemic saw a surge in services demanded across these digital platforms, with medium- to longer-term services, such as sleep-over services, increasing by 160% in Spain (Arroyo et al. 2021).

3. Mitigating Measures

One of the consequences of the pandemic was the mounting visibility of live-in migrant carers and the growing pressure on families and persons with care needs who employed a migrant carer. This pressure also reached policy makers rather quickly—and similar to several other areas, the pandemic accelerated the invention of quick fixes such as ‘bonus payments’ and ‘regularisation’. In the following, related interventions in Austria, Italy and Spain are outlined.

3.1. From Panicking to More Structured Interventions in Austria

Faced with the disruptive impact of the pandemic on cross-border care and alongside media attention on the situation of live-in carers in Austria (e.g., Scherndl 2020), the federal state, regional governments, the Economic Chamber (federally and regionally), live-in carer agencies and the Austrian Railways introduced a range of mitigating measures. The regional governments of Lower Austria and Burgenland organised charter flights for Romanian and Bulgarian live-in carers to return to Austria (Schmidt et al. 2020; Leiblfinger et al. 2021). A total of 355 individuals were transported with charter flights and up to 2000 on six special trains for live-in carers from Romania (Leiblfinger et al. 2021; Aulenbacher et al. 2020). In view of about 30,000 individuals who were cared for by a live-in carer at the outbreak of the pandemic, only a minority of live-in carers used this transport (Leiblfinger et al. 2021). With the re-opening of the borders, the charter flights and trains were discontinued. After crossing the border, quarantine regulations meant that live-in carers had to stay for 14 days in a hotel and pay a small sum towards the accommodation costs (Leichsenring et al. 2021). Initially, public authorities confiscated their passports for as long as they were staying in hotels, which was discontinued after a public outcry (Miedl 2020).

Before tests became freely available to the public, there was a lack of regulations on who had to pay for tests of live-in carers (Leiblfinger et al. 2021). The Economic Chamber started a phone hotline to offer psychological support—this service was, however, not able to ensure a sufficient number of professionals fluent in the mother tongues of live-in carers (Schmidt et al. 2020). Regional governments and the federal government introduced a bonus for live-in carers who would prolong their shift in Austria in the weeks following the start of the first lockdown. Those who prolonged their stay for at least four weeks could receive EUR 500 (Leiblfinger et al. 2021). However, this was paid out in different ways according to the region, i.e., to live-in carers with an Austrian bank account only, to live-in carers directly, to agencies of live-in carers or to care receivers. Some regional governments introduced an additional bonus, such as the EUR 1000 bonus in Upper Austria (Schmidt et al. 2020). The federal government also created a hardship fund for businesses that had lost income due to COVID-19. As many live-in carers are self-employed, they were eligible to receive up to EUR 2500 for a maximum of six months (Leiblfinger et al. 2020). However, to receive this, an income tax assessment notice, a tax number and an Austrian bank account were required, which live-in carers often did not have since their earnings were below the tax threshold (Leiblfinger et al. 2020).

3.2. Almost 177,000 More Registered ‘Badanti’ in Italy

In Italy, the situation of migrant carers who were in the country at the onset of the pandemic became immediately critical, in particular for those who were not registered. The severe lockdown regulations stipulated that only those who could prove their status, i.e., registered carers, were allowed to travel more freely outside the household—and from home to their workplace (for live-out carers). One of the first reactions of many local authorities was therefore to organise an emergency registration of non-registered migrant carers so that they were able to move. Moreover, as registered personal assistants, they could apply for social assistance and get access to other social support, namely a bonus of EUR 600 that was stipulated by the Italian government in April 2020. For more than 200,000 migrant carers, however, this option did not work out, as many did not hold a residence permit. Another governmental decree in May 2020 therefore paved the way for families to regularise hitherto unregistered carers by paying a one-off contribution of EUR 500.

Table 1. Registered domestic workers (live-in carers and cleaners) in Italy by country of origin in 2019 and requests for regularisation in 2020.

Country of Origin	Registered Workers, 2019		Requests for Regularisation, 2020
	n.	in %	n.	in %
Eastern Europe	347,032	40.9	45,924	25.9
Italy	252,023	29.7	-	-
Philippines	67,000	7.9	-	-
South America	58,795	6.9	13,711	7.7
East Asia	44,910	5.3	50,529	28.8
Northern Africa	29,664	3.5	22,213	12.5
Sub-Saharan Africa	18,609	2.2	-	-
Central America	14,912	1.8	-	-
Other nationalities	16,041	1.8	44,471	25.1
Total	848,987	100.0	176,848	100.0

Source: (Pasquinelli and Pozzoli 2021, p. 7).

shows the outcome of this opportunity that gave almost 177,000 domestic workers (no data differentiated by cleaners and live-in carers available) some more visibility and the possibility to move into the public sphere. Pasquinelli and Pozzoli (2021) suspected, however, that this peak of registrations will be reabsorbed soon by newly arriving domestic workers in the black market.

In many cases, support was provided by the third sector, namely religious associations and cooperatives. During a certain period in 2020, an acute shortage of carers could be observed as those who had returned to their home country could not return to Italy due to travel restrictions. However, data on the real number of repatriates and the net loss of live-in carers in Italy cannot be retrieved. This is in part due to the outburst of the war in Ukraine, as the number of carers and migrants from this country in Italy is currently difficult to gauge.

3.3. From Special Subsidies to Attempted Regularisation—And Back to the Starting Position in Spain

Although poor working conditions and unequal labour rights in the domestic care sector have occasionally been addressed by the Spanish government previously in the form of regularisation processes and reforms, a number of measures enacted since March 2020 have suggested the pandemic to be a catalyst for the increasing visibility of live-in care work in the country and subsequent mitigating measures. On 1 April 2020, the government of Spain announced that laid-off domestic workers who previously paid into social contributions would be entitled to a special subsidy amounting to 70% of their contribution base, to a maximum of EUR 950 (Parella Rubio 2021). While this subsidy in part indicated an increasing recognition of the precarious position of domestic workers and the importance of their work, naturally, this policy did not extend to unregistered live-in carers. Additionally, there were increasing calls for recognition of migrant care workers in Spain as essential workers and for the regularisation of undocumented migrant workers in general by organisations and media outlets (van Hooren 2020). The platform RegularizaciónYa (Regularisation Now) brought together 100 associations and organisations that proposed such a measure to the government to recognize and regularize undocumented migrant care workers. Supported by six political parties at the time, including one part of the government coalition, the measure was rejected and subsequently not passed.

3.4. National Visibility and National Mitigation

This short overview of national measures that were implemented in individual Member States shows that politics were able to develop some mitigating national short-term strategies under pressure and at short notice. These were partly influenced by the national framework conditions of live-in migrants in the respective countries. For instance, providing information in migrant carers’ mother tongue became partly necessary in Austria as not all live-in carers are able to deal with bureaucratic German used in sophisticated application forms, e.g., to apply for a bonus payment or an exemption from travel restrictions. This was less critical in Italy and Spain as both live-in and live-out carers were essentially living with the clients, mainly with only one longer spell in their home country per year (for vacation), rather than two- to four-week shifts alongside a ‘counterpart’ as in the case of Austrian live-in care arrangements. In this sense, the Italian and the Spanish system could be viewed as more resilient in the situation of a pandemic outbreak (van Hooren 2020), as most live-in carers did not need to travel back and forth across borders. The overview in

Table 2. Overview of measures to mitigate critical situations in the area of live-in migrant care.

	Austria	Italy	Spain
Information in migrant carers’ mother tongue	yes, partly	partly	no, but less important
Regularisation	no *	yes, as emergency measure	raised as emergency measure but did not pass
One-off bonus payment	yes, EUR 500–1000 with strings and regional differences	yes, EUR 600 with strings	no
Travel facilitation	yes, for a small group only; low take-up	no, only local during lockdowns	no
Support in case of unemployment	no	no	yes, for registered workers
Vaccination campaign	yes	yes, obligatory vaccination	no
Psychological support	yes, restricted	no	no
Other visibility	political mobilisation; media coverage; union support	some media coverage	some media coverage; political mobilisation; digital platforms

Source: own compilation. Note: * Regularisation of live-in carers as ‘personal carers’ has taken place since 2007; moonlighting has been almost totally curbed in Austria.

further shows that in Italy and Spain, the pandemic clearly contributed to making hitherto ‘illegal’ care arrangements visible and boosting the ‘regularisation’ of employment contracts for live-in migrant carers, an issue that had been resolved in Austria already for more than a decade when it had been regulated under the title of ‘personal care’, including subsidies for social security contributions. Still, social security in case of unemployment remains a major issue for live-in carers in all countries, be it due to their status of ‘self-employment’ (Austria) or the generally denied access to unemployment insurance in Italy and Spain; only in Spain, a dedicated one-time ‘special subsidy’ was introduced—again, as a result of the experiences during the pandemic. This is also true for some political mobilisation and new trends such as recruitment via digital platforms and care work becoming a part of the platform economy (Digital Future Society 2021).

The experiences during the pandemic have triggered some political debates regarding the regularisation of live-in care, new regulations and issues of wages and working conditions. In Spain, an attempt for legal amendments and to regularize undocumented migrant workers failed. In Austria, the Economic Chamber as the legal interest representation of self-employed ‘personal carers’ has started to campaign for higher public subsidies up to the average public subsidy paid for a place in a care home (around EUR 1650 per month) so that registered live-in carers can claim higher wages. The Austrian branch of Amnesty International published a study that criticizes the lack of rights and the low wages paid to self-employed personal carers between EUR 10,000 and EUR 12,000 per year, which is about a third of the average wage in Austria. Although formally self-employed, personal carers cannot decide autonomously on their working time, breaks or absences, and sickness leave is only paid in case of long-term sickness of more than 42 days; contracts are often concluded between the brokering agency and the family, rather than with the live-in carer her/himself (Amnesty International 2021). In Italy, the National Association of Families as Employers in Domestic Work (Associazione Nazionale Famiglie Datori di Lavoro Domestico) is one of the drivers towards regulation and, in particular, the negotiation of collective agreements with the unions representing domestic workers. The social partners in Italy have agreed on a joint platform to further promote improvements in the sector regarding sickness payments, parental leaves, the possibility of tax deductions for employers of domestic workers, reforms in immigration law regarding domestic workers and a general service voucher for people with care needs (Osservatorio Nazionale 2021).

4. Discussion and Outlook

This contribution showed the increasing visibility of care work that has augmented with the experience of the COVID-19 pandemic, however with unequal, often unintended, and in many cases legally doubtful or still unregulated consequences. Lockdowns, general restrictions, opportunities for teleworking and new types of co-living have contributed to a revival of role models between men and women in unpaid (care) work (OECD 2021). This has also impacted arrangements in which care has been outsourced, if not ‘globalised’, by middle-class families to live-in migrant carers from countries with lower wage levels and higher unemployment. As these arrangements are often still part of the ‘do-it-yourself’ welfare model, they came under pressure when formal regulations under conditions of the pandemic kicked in and restricted travels, movement in public spaces and social contacts in general. As support measures were also linked to formal employment relations, firms or branches, all those care arrangements without ‘registration’ or formal underpinning came under pressure which became visible in particular in Italy and Spain but also in Austria where the peculiar working time regulations linked to working in fortnightly turns contributed to the visibility of live-in care arrangements. It is therefore necessary, as a first step against discrimination and exploitation, to continue with the formalisation and registration of these care arrangements, as it is unlikely that in a mid-term perspective, these arrangements will disappear completely. While universal care regimes and those with more expanded formal care structures have not yet allowed for live-in care arrangements, care regimes with a bias on family responsibility for care in combination with cash benefits (such as Austria, Italy and Spain) will to a certain degree continue to rely on live-in carers, typically with a migrant background. It remains to be seen whether there will be a development towards a live-in or a live-out model and whether there will be an increase in migrant carers from other continents. It can, however, be assumed that some of the current source countries might further wither away due to converging wages and long-term care systems. Although there has been some visibility and acknowledgement, further awareness raising is needed to avoid ‘illegal’ and unregulated care relationships that are often even promoted as a ‘win-win situation’ for all involved: while families are able to outsource care responsibilities, migrant carers find employment and income which enables them to financially sustain their family at home. The social and economic impact of these care arrangements must therefore not be underestimated. For instance, remittances of migrant carers make up more than EUR 6 billion in Italy alone (Osservatorio Nazionale 2021). Moreover, national care regimes are avoiding investments in their long-term care systems, e.g., it can be estimated that, without live-in carers, Austria would need at least 15,000 additional places in residential care homes.

However, these ‘gains’ come with a price that cannot be expressed in mere economic terms—the thinning of the social tissue in source countries and social exclusion of live-in carers. One possibility to overcome the social exclusion of migrant live-in carers would be to conceive of this group of carers as a source of recruiting for the formal care workforce. While this would certainly require an investment in education and training, it could constitute a true win-win condition for migrant carers and the national long-term care systems. For instance, if only 10% of registered live-in carers in Austria could be attracted to join the formal LTC workforce, an important gap in the sector could be closed. Such a strategy could be even more gainful in Italy and Spain where the majority of live-in carers with a migrant background are fully residing in these countries already.

With formal long-term care delivery moving towards more integrated, user-centred and sustainable systems, it will be necessary to also address the working conditions in the area of live-in migrant care, including quality assurance and employment status. The tokenistic status of self-employment, as practiced in Austria, will definitely need a revision as long as live-in carers remain dependent on agencies and with restricted rights in their relation to their ‘client-employers’. Enhancing the social rights of live-in carers would, however, increase the costs of such arrangements and could further contribute to a development in which live-in care would only be affordable for an ever smaller group of families who can afford it—minor improvements will thus not suffice, and a larger reform of (hitherto) unpaid care work would be needed. As Leiblfinger et al. (2020) put it, ‘we need to adjust our care policies in a way that they cease to rely on social and gender inequalities and uninhibited transnational mobility as an essential prerequisite and enable care workers to have a decent life alongside their work’. While initiatives such as the ILO Domestic Workers Convention 189 could be a helpful instrument to forward migrant live-in carers’ rights, the Convention that entered into force in 2013 (ILO 2021) has since been ratified by only 35 countries, including for instance Italy, but not by Austria and Spain (www.ilo.org, accessed on 28 April 2022).

5. Conclusions

Altogether it can be concluded that migrant care work has gained visibility during the pandemic, in some cases even to the degree that other forms of (formal) long-term care were perceived as secondary. However, it is striking that the individual strategies remained at the national, and sometimes even tied to the regional levels only. Coordination, mutual information and the agreement on joint strategies with and among Member States were much less perceivable than in the entire management of the pandemic. The opportunity to discuss policies with both receiving countries and countries of origin was not even seen within the EU, not to speak of third countries such as Moldova, Ukraine or Belarus. These countries of origin will, however, have to face the long-term consequences of the political economy of care migration in Europe. While countries such as the Czech Republic and Slovakia have already started to increase wages in the health and social care sectors to prevent staff from emigrating to Western Europe, most other source countries still need to start counteracting the challenge of staff shortages in health and long-term care.

The visibility of migrant live-in care thus remains tightly connected to the further development of care regimes and the acknowledgement of unpaid work as a precondition for gender equality and equal opportunities in a European and subsequently in a global dimension.